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Current Opinion in Organ Transplantation Jun 2020In this article, an overview of the survival after lung transplantation will be given, with a focus on factors affecting outcome and differences in survival determined... (Review)
Review
PURPOSE OF REVIEW
In this article, an overview of the survival after lung transplantation will be given, with a focus on factors affecting outcome and differences in survival determined by underlying disease.
RECENT FINDINGS
Lung transplantation is an established treatment modality for patients with various end-stage lung diseases. The most recent International Society for Heart and Lung Transplantation Registry reports a 1 and 5-year survival of 85 and 59%, respectively, for adult lung transplant recipients transplanted since 2010. Over the past decades, significant improvements in patient outcomes have been achieved related to changes in donor selection, organ preservation, perioperative management and better treatment of postoperative complications. However, long-term graft and patient outcomes still lag behind that of other solid organ transplantations. Chronic lung allograft dysfunction (CLAD) a condition which develops in about 50% of recipients 5 year after lung transplantation, remains the major barrier for long-term survival, although development of solid organ cancer is nowadays also an increasing cause of late mortality.
SUMMARY
Lung transplantation offers a survival benefit in well chosen patients with end-stage lung diseases. However, CLAD, side effects of immunosuppressive therapy and solid organ cancer remain important challenges impairing long-term survival. Advances in prevention and treatment of chronic rejection are critical to further improve outcome.
Topics: Adult; History, 21st Century; Humans; Lung Transplantation; Postoperative Complications
PubMed: 32332197
DOI: 10.1097/MOT.0000000000000753 -
Chest Mar 2019The field of lung transplant has made significant advances over the last several decades. Despite these advances, morbidity and mortality remain high when compared with... (Review)
Review
The field of lung transplant has made significant advances over the last several decades. Despite these advances, morbidity and mortality remain high when compared with other solid organ transplants. As the field moves forward, the speed by which progress can be made will in part be determined by our ability to overcome several stumbling blocks, including donor shortage, proper selection of candidates, primary graft dysfunction, and chronic lung allograft dysfunction. The advances and developments surrounding these factors will have a significant impact on shaping the field within the coming years. In this review, we look at the current climate (ripe for expanding the donor pool), new technology (ex vivo lung perfusion and bioengineered lungs), cutting-edge innovation (novel biomarkers and new ways to treat infected donors), and evidence-based medicine to discuss current trends and predict future developments for what we hope is a bright future for the field of lung transplantation.
Topics: Biomedical Technology; Donor Selection; Forecasting; Graft Rejection; Lung Diseases; Lung Transplantation; Primary Graft Dysfunction
PubMed: 30171860
DOI: 10.1016/j.chest.2018.08.1036 -
Seminars in Pediatric Surgery Aug 2017Pediatric lung transplantation is a highly specialized clinical endeavor. Since the late 1980's, there have only been slightly more than 2200 implants reported to the... (Review)
Review
Pediatric lung transplantation is a highly specialized clinical endeavor. Since the late 1980's, there have only been slightly more than 2200 implants reported to the International Society for Heart and Lung transplantation registry. This review will discuss the historical aspects of pediatric lung transplantation. It will familiarize the reader with the current indications for transplant and the referral and listing process. The current state of lung assist devices as a bridge to pediatric lung transplantation is discussed in addition to the technical aspects of the transplant procedure. Finally, posttransplant outcomes, including anticipated morbidity and the role of retransplantation, are clarified.
Topics: Child; Extracorporeal Membrane Oxygenation; Humans; Lung Diseases; Lung Transplantation; Referral and Consultation; Reoperation
PubMed: 28964476
DOI: 10.1053/j.sempedsurg.2017.07.005 -
Current Opinion in Organ Transplantation Oct 2012Re-transplantation of the lung has come of age. Here, we wish to review the recent literature on the topic and discuss clinical implications. (Review)
Review
PURPOSE OF REVIEW
Re-transplantation of the lung has come of age. Here, we wish to review the recent literature on the topic and discuss clinical implications.
RECENT FINDINGS
Many large volume transplant centres routinely perform lung re-transplantation with satisfactory outcomes. The main indication is bronchiolitis obliterans syndrome, that is chronic rejection of a previous lung transplant. Other indications, such as primary graft failure or early airway complications, are regarded with more caution, as outcomes compare less favourably with those following primary transplantation.
SUMMARY
Re-transplantation of the lung can be performed safely and with outcomes rivalling those of primary transplants in carefully selected recipients with chronic rejection of a previous transplant.
Topics: Bronchiolitis Obliterans; Humans; Lung Transplantation; Reoperation
PubMed: 22907540
DOI: 10.1097/MOT.0b013e328357d8ba -
American Journal of Respiratory and... Jul 2011First performed in 1963, lung transplantation is approaching the half-century mark. With more than 32,000 procedures having been performed worldwide, lung... (Review)
Review
First performed in 1963, lung transplantation is approaching the half-century mark. With more than 32,000 procedures having been performed worldwide, lung transplantation has become the standard of care for select patients with advanced lung diseases of various nonmalignant etiologies. Indications for transplantation have broadened over the years, and selection criteria have become less restrictive. A relatively scarce donor pool limits wider application of this therapy, but this is being addressed in part through relaxation of donor selection criteria, donor management protocols that preserve and optimize lung function, and development of ex vivo perfusion techniques to "recondition" suboptimal organs. Bilateral lung transplantation has become the procedure of choice for most indications, although its preferential use in patients with idiopathic pulmonary fibrosis remains controversial. Post-transplantation survival has steadily improved, but significant constraints on long-term survival persist as evidenced by a median survival rate that currently stands at 5.7 years. This has brought into focus the question of whether and for whom transplantation actually confers a survival advantage, a question that in the absence of randomized trials can only be answered with statistical modeling. Primary graft dysfunction, infection, and bronchiolitis obliterans syndrome are common complications encountered by the lung transplant recipient and are major impediments to long-term survival. This review provides an overview of the current status of lung transplantation, highlighting both the many advances that have taken place and the challenges that remain.
Topics: Bronchiolitis Obliterans; Donor Selection; Graft Rejection; Humans; Lung Diseases; Lung Transplantation; Patient Selection; Survival Rate
PubMed: 21471083
DOI: 10.1164/rccm.201101-0134CI -
Cells May 2021Lung transplantation has been established worldwide as the last treatment for end-stage respiratory failure. However, ischemia-reperfusion injury (IRI) inevitably occurs... (Review)
Review
Lung transplantation has been established worldwide as the last treatment for end-stage respiratory failure. However, ischemia-reperfusion injury (IRI) inevitably occurs after lung transplantation. The most severe form of IRI leads to primary graft failure, which is an important cause of morbidity and mortality after lung transplantation. IRI may also induce rejection, which is the main cause of mortality in recipients. Despite advances in donor management and graft preservation, most donor grafts are still unsuitable for transplantation. Although the pulmonary endothelium is the primary target site of IRI, the pathophysiology of lung IRI remains incompletely understood. It is essential to understand the mechanism of pulmonary IRI to improve the outcomes of lung transplantation. Therefore, we reviewed the state-of-the-art in the management of pulmonary IRI after lung transplantation. Recently, the ex vivo lung perfusion (EVLP) system has been clinically introduced worldwide. Various promising therapeutic strategies for the protection of the endothelium against IRI, including EVLP, inhalation therapy with therapeutic gases and substances, fibrinolytic treatment, and mesenchymal stromal cell therapy, are awaiting clinical application. We herein review the latest advances in the field of pulmonary IRI in lung transplantation.
Topics: Animals; Humans; Lung Transplantation; Reperfusion Injury
PubMed: 34071255
DOI: 10.3390/cells10061333 -
Pediatric Clinics of North America Apr 2010Lung transplantation is an accepted therapy for selected pediatric patients with severe end-stage vascular or parenchymal lung disease. Collaboration between the... (Review)
Review
Lung transplantation is an accepted therapy for selected pediatric patients with severe end-stage vascular or parenchymal lung disease. Collaboration between the patients' primary care physicians, the lung transplant team, patients, and patients' families is essential. The challenges of this treatment include the limited availability of suitable donor organs, the toxicity of immunosuppressive medications needed to prevent rejection, the prevention and treatment of obliterative bronchiolitis, and maximizing growth, development, and quality of life of the recipients. This article describes the current status of pediatric lung transplantation, indications for listing, evaluation of recipient and donor, updates on the operative procedure,graft dysfunction, and the risk factors, outcomes, and future directions.
Topics: Child; History, 20th Century; Humans; Infant; Living Donors; Lung Transplantation; Patient Selection; Postoperative Complications; Transplantation Immunology; Treatment Outcome
PubMed: 20371042
DOI: 10.1016/j.pcl.2010.01.017 -
The New England Journal of Medicine Apr 1999
Review
Topics: Graft Rejection; Health Care Rationing; Humans; Lung Transplantation; Patient Selection; Postoperative Complications; Quality of Life; Survival Analysis; Treatment Outcome
PubMed: 10194239
DOI: 10.1056/NEJM199904083401406 -
Current Opinion in Organ Transplantation Oct 2014
Topics: Humans; Lung Transplantation
PubMed: 25160700
DOI: 10.1097/MOT.0000000000000123 -
American Journal of Respiratory and... Mar 1997
Review
Topics: Bronchiolitis Obliterans; Cytomegalovirus Infections; Graft Rejection; Humans; Lung; Lung Diseases; Lung Transplantation; Organ Preservation; Patient Selection; Postoperative Care; Postoperative Complications; Spirometry
PubMed: 9117010
DOI: 10.1164/ajrccm.155.3.9117010